Transforming End of Life
Quality care at the end of life (EOL) should involve honoring a person’s preferences, values, and beliefs; be based on evidence-based medicine; and allow for sound, informed medical decisions made collaboratively and deliberately among the individual, family/caregiver, and healthcare professionals. Substantial evidence shows that the treatment people receive is, more commonly, different—and often times more aggressive—than the care they desire at the EOL. Conversely, some individuals, particularly those with disabilities, find that the healthcare system, and sometimes their families, undervalue their quality of life and, as a result, withhold life-prolonging treatments that they would want to receive (Report to Congress 2008).
The Institute of Medicine identified a need for public education and engagement about EOL care planning at several levels: 1) societal: to build support for public and institutional policies that ensure high-quality, sustainable care; 2) community and family: to raise awareness and elevate expectations about care options, the needs of caregivers, and the hallmarks of high-quality care; and 3) individual: to motivate and facilitate advance care planning (ACP) and meaningful conversations with family members and caregivers (IOM 2014).
Medical Orders for Life-Sustaining Treatment (MOLST) is designed to improve the quality of care people receive at the EOL. MOLST is New York State’s Physicians Orders for Life-Sustaining Treatment (POLST) Paradigm Program. These programs are based on effective communication of patient wishes, documentation of medical orders on a brightly colored form to ensure visibility, and a promise by healthcare professionals to honor these wishes.
eMOLST is a secure web-based application that allows enrolled users to complete the MOLST form, MOLST Chart Documentation Form (CDF) and mandated Office for Persons with Developmental Disabilities (OPWDD) Checklist for persons with developmental disabilities who lack capacity. CDFs document the MOLST discussion including the patient’s values, beliefs, and goals for care; the ethical framework for medical decisions regarding withholding and withdrawing life-sustaining treatment; and legal requirements. Forms are created as pdf documents that can be printed for the patient and paper-based medical records, stored or linked to/from an electronic medical record (EMR), and become part of the NYS eMOLST registry. eMOLST includes programming to eliminate errors; guides conversations among clinicians, the patient or medical decision-maker, and family members; and incorporates the ethical framework and legal requirements for making decisions regarding cardiopulmonary resuscitation (CPR) and life-sustaining treatment, and documentation of the discussion.
AQIN-NY (IPRO) has worked to educate New York’s Medicare beneficiaries and their families/caregivers on the importance of ACP, terminology used by medical professionals, and how to communicate with healthcare professionals about their EOL wishes as well as prepare documentation to ensure they are properly carried out. Staff members use the ACP programs "Community Conversations on Compassionate Care and What Matters Most?" to educate beneficiaries about planning for their medical care and prepare them for the possibility of being unable to make their own care decisions as, for example, they enter the advance stages of chronic illness.
AQIN-NY has also provided technical support to hospitals, skilled nursing facilities (SNFs), home health agencies (HHAs), hospices, emergency medical services (EMS), and physician practices for adoption, training and implementation of MOLST and eMOLST.
Listen to the replay and understand:
- The drivers accelerating the need for value-based end-of-life care and planning.
- The business case, examples and challenges for developing and implementing value-based end-of-life care programs, policies, and initiatives.
- The added complexities of end-of-life-care and planning for special populations such as people with serious mental illness, and the benefit of using trauma informed care models for such end-of-life care and planning.
Gitenstein Institute for Health Law and Policy at the Maurice A. Deane School of Law at Hofstra University and the North Shore-LIJ Health System Conversations Health And Treatments (CHAT) Project - http://www.thechatproject.org